Analysis of motor, cognitive and language performance of infants undergoing treatment for congenital hypothyroidism.

OBJECTIVE: Investigate the association between the age of treatment onset and confirmatory TSH level (as an indicator of severity) with a greater risk of developmental delay in infants with congenital hypothyroidism (CH). METHOD: The authors conducted a cross-sectional, observational, unmatched case-control study at a Brazilian neonatal screening reference center. Seventy-seven infants with CH (mean age: 12 ± 6.4 months) were examined. The authors evaluated their performance using the Bayley-III Screening Test and categorized them as "LOWER RISK" (competent category) or "GREATER RISK" (combined at-risk + emergent categories) for developmental delay based on the 25th percentile cutoff. RESULTS: Infants with CH are at a higher risk of non-competent performance in cognition, receptive language, fine motor skills, and gross motor skills when compared to infants without CH. This risk is more pronounced in infants with more severe indications of CH (TSH > 30 µUI/L in the confirmatory test) for cognition (OR = 5.64; p = 0.01), receptive language (OR = 14.68; p = 0.000), fine motor skills (OR = 8.25; p = 0.000), and gross motor skills (OR = 5.00; p = 0.011). CONCLUSION: The level of TSH in the confirmatory test can be a good indicator for identifying infants with CH who are at a higher risk of non-competent performance in cognition, receptive language, and motor skills. Monitoring development, early detection of delays, and intervention programs are particularly important for infants with CH.

Neonatal screening: 9% of children with filter paper thyroid-stimulating hormone levels between 5 and 10 µIU/mL have congenital hypothyroidism / Triagem neonatal: 9% das crianças com TSH em papel filtro entre 5 e 10 µUI/mL têm hipotireoidismo congênito

Abstract Objectives: To determine the prevalence of congenital hypothyroidism in children with filter-paper blood-spot TSH (b-TSH) between 5 and 10 µIU/mL in the neonatal screening. Methods: This was a retrospective study including children screened from 2003 to 2010, with b-TSH levels between 5 and 10 µIU/mL, who were followed-up during the first two years of life when there was no serum TSH normalization. The diagnosis of congenital hypothyroidism was defined as serum TSH ≥10 µIU/mL and start of levothyroxine treatment up to 2 years of age. Results: Of the 380,741 live births, 3713 (1.04%) had filter paper TSH levels between 5 and 10 µIU/mL and, of these, 339 (9.13%) had congenital hypothyroidism. Of these, 76.11% of the cases were diagnosed in the first three months of life and 7.96% between 1 and 2 years of age. Conclusion: The study showed that 9.13% of the children with b-TSH levels between 5 and 10 µIU/mL developed hypothyroidism and that in approximately one-quarter of them, the diagnosis was confirmed only after the third month of life. Based on these findings, the authors suggest the use of a 5 µIU/mL cutoff for b-TSH levels and long-term follow-up of infants whose serum TSH has not normalized to rule out congenital hypothyroidism.

Resumo Objetivos: Determinar a prevalência de hipotireoidismo congênito em crianças com TSH em papel filtro (TSH-f) entre 5 e 10 µUI/mL na triagem neonatal. Métodos: Estudo retrospectivo que incluiu crianças triadas de 2003 a 2010, com TSH-f entre 5 e 10 µUI/mL, acompanhadas nos dois primeiros anos de vida quando não houve normalização do TSH sérico. O diagnóstico de hipotireoidismo congênito foi definido como TSH sérico igual ou superior a 10 µUI/mL e início de tratamento com levotiroxina até os dois anos. Resultados: Dos 380.741 nascidos vivos triados, 3.713 (1,04%) apresentaram TSH-f entre 5 e 10 µUI/mL e, desses, 339 (9,13%) tinham hipotireoidismo congênito. Desses, 76,11% dos casos foram diagnosticados nos primeiros três meses de vida e 7,96% entre um e dois anos. Conclusão: O estudo mostra que 9,13% das crianças com TSH-f entre 5 e 10 µUI/mL desenvolveram hipotireoidismo e que em cerca de um quarto delas o diagnóstico só se confirmou após o terceiro mês de vida. Com base nesses achados, sugere-se, para descartar o hipotireoidismo congênito, o uso do ponto de corte de TSH-f de 5 µUI/mL e o acompanhamento em longo prazo dos lactentes cujo TSH sérico não tenha se normalizado.

Neonatal screening: 9% of children with filter paper thyroid-stimulating hormone levels between 5 and 10µIU/mL have congenital hypothyroidism.

OBJECTIVES: To determine the prevalence of congenital hypothyroidism in children with filter-paper blood-spot TSH (b-TSH) between 5 and 10µIU/mL in the neonatal screening. METHODS: This was a retrospective study including children screened from 2003 to 2010, with b-TSH levels between 5 and 10µIU/mL, who were followed-up during the first two years of life when there was no serum TSH normalization. The diagnosis of congenital hypothyroidism was defined as serum TSH ≥10µIU/mL and start of levothyroxine treatment up to 2 years of age. RESULTS: Of the 380,741 live births, 3713 (1.04%) had filter paper TSH levels between 5 and 10µIU/mL and, of these, 339 (9.13%) had congenital hypothyroidism. Of these, 76.11% of the cases were diagnosed in the first three months of life and 7.96% between 1 and 2 years of age. CONCLUSION: The study showed that 9.13% of the children with b-TSH levels between 5 and 10µIU/mL developed hypothyroidism and that in approximately one-quarter of them, the diagnosis was confirmed only after the third month of life. Based on these findings, the authors suggest the use of a 5µIU/mL cutoff for b-TSH levels and long-term follow-up of infants whose serum TSH has not normalized to rule out congenital hypothyroidism.

Prevalência de transtornos mentais comuns entre idosos residentes em município do Nordeste do Brasil / Prevalence of common mental disorders among elderly residents county in northeast of Brazil / Prevalencia de desórdenes mentales comunes en individuos de tercera edad, residentes en un municipio del Noreste de Brasil

Objetivo: Descrever a prevalência de transtornos mentais comuns segundo características sociodemograficas e presença de doenças crônicas entre residentes idosos de áreas urbanas de Feira de Santana, Bahia, Brasil. Materiais e Métodos: Estudo transversal com amostra constituída de 562 indivíduos residentes idosos no município de Feira de Santana, 69,6 % do sexo feminino e 30,4 % do sexo masculino com média de idade de 68,93±7,05 anos. Foi utilizado um formulário contendo informações sociodemograficas, doenças referidas, triagem para Transtornos Mentais Comuns (TMC) utilizando o Self Reporting Questionnaire. Para análise estatística foi utilizado à técnica de regressão logística, com o cálculo das razões de prevalência, intervalo de confiança (95 %) e nível de significância p≤0,05. Resultados: A prevalência global de TMC foi 32,1 %. A análise dos dados revelou que características sociodemograficas (idade e renda) estavam associadas à maior prevalência de TMC. Conclusão: O estudo permitiu estimar a prevalência de TMC na população de idosos residentes em um município localizado no nordeste do Brasil e identificar características associadas aos TMC que podem interferir na saúde mental da população estudada. Neste sentido, as políticas de atenção à saúde mental do município devem estar articuladas a políticas de renda mínima para a população idosa.

Objective: Describing the prevalence of commonly occurring mental disorders, according to sociodemographic characteristics and the presence of chronic disease, amongst elderly residents living in urban areas of Feira de Santana, Bahia, Brazil. Materials and Methods: The study involved a cross-sectional sample consisting of 562 individuals living in the city of Feira de Santana (69.6 % female, 30.4 % male: 68.93±7.05 years old mean age). A questionnaire asking for pertinent sociodemographic information was used, such as diseases, screening for common mental disorders (CMD) using the self-reporting questionnaire. Logistic regressionwas used for statistical analysis; the prevalence ratio, confidence interval (95 %) and p≤0.0 5significance level were calculated. Results: Overall CMD prevalence was 32.1 %. Data analysis revealed that sociodemographic characteristics (age and income) were associated with higher CMD prevalence. Conclusion: This study estimated CMD prevalence in elderly people residing in a municipality in north-eastern Brazil and identified the characteristics associated with CMD which could interfere with the population’s mental health. The city’s mental healthcare policy should be coordinated with minimum income policy for the elderly population.

Objetivo: Describir la prevalencia de transtornos mentales comunes según sociodemograficas caracteristicas y las de enfermedades crónicas entre los ancianos residentes en las zonas urbanas de Feira de Santana, Bahia, Brasil. Materiales y Métodos: Estudio transversal de una muestra de 562 ancianos que viven en la cuidad de Feira de Santana, el 69,6% mujeres y 30,4 % varones con una edad media de 68,93±7,05 años. Se utilizó un formulario con información sociodemografica, las enfermedades, la detección de trastornos mentales comunes (TMC). Para el análisis estadístico, la regresión logística, con el cálculo de las tasas de prevalencia, intervalos de confianza (95 %) y el nivel de significación p ≤ 0,05. Resultados: La prevalencia global de CMD fue del 32,1 %. El análisis de datos reveló que las características sociodemográficas (edad e ingresos) se asociaron con una mayor prevalencia de TMC (p≤0,05). Conclusiones: El estudio permitió estimar la prevalencia de CMD en la población de ancianos residentes en un municipio situado en el nordeste de Brasil e identificar las características asociadas con el TMC que puede interferir con la salud mental de la población. En este sentido, la política de atención de salud mental en el municipio debe articularse la política de ingresos mínimos a la población anciana.

Comparison of motor and cognitive performance in infants during the first year of life.

PURPOSE: To compare motor and cognitive performance in infants with typical development in the 1st, 2nd, 3rd, 6th, 9th, and 12th months after birth. METHODS: This was a repeated-measures study with unequal sample sizes in the follow-up periods, comprising 94 infants born at term. Infants with genetic syndromes, malformations, congenital infections, or hospitalized in intensive care units were excluded. The Bayley Scales of Infant Development II were used for evaluation of cognitive and motor performance. RESULTS: There were significant differences between motor and cognitive performance at 1, 2, and 3 months. However, at 6, 9, and 12 months, there was no difference between domains. CONCLUSION: This study suggests that during the first year, development can be synchronous in the 2 areas evaluated by the Bayley Scales of Infant Development II, especially from the sixth month of age onward.

[Prevalence of common mental disorders among elderly residents county in northeast of Brazil]. / Prevalência de transtornos mentais comuns entre idosos residentes em município do Nordeste do Brasil.

OBJECTIVE: Describing the prevalence of commonly occurring mental disorders, according to sociodemographic characteristics and the presence of chronic disease, amongst elderly residents living in urban areas of Feira de Santana, Bahia, Brazil. MATERIALS AND METHODS: The study involved a cross-sectional sample consisting of 562 individuals living in the city of Feira de Santana (69.6 % female, 30.4 % male: 68.93±7.05 years old mean age). A questionnaire asking for pertinent sociodemographic information was used, such as diseases, screening for common mental disorders (CMD) using the self-reporting questionnaire. Logistic regression was used for statistical analysis; the prevalence ratio, confidence interval (95 %) and p≤0.0 5 significance level were calculated. RESULTS: Overall CMD prevalence was 32.1 %. Data analysis revealed that sociodemographic characteristics (age and income) were associated with higher CMD prevalence. CONCLUSION: This study estimated CMD prevalence in elderly people residing in a municipality in north-eastern Brazil and identified the characteristics associated with CMD which could interfere with the population's mental health. The city's mental healthcare policy should be coordinated with minimum income policy for the elderly population.

Bone marrow necrosis related to paracoccidioidomycosis: the first eight cases identified at autopsy.

AIMS: To report the first eight bone marrow necrosis (BMN) cases related to paracoccidioidomycosis (PCM) from patient autopsies with well-documented bone marrow (BM) histology and cytology. METHODS AND RESULTS: A retrospective evaluation was performed on BM specimens from eight autopsied patients from Botucatu University Hospital with PCM-related BMN. Relevant BMN literature was searched and analysed. CONCLUSIONS: All eight patients had acute PCM. Six had histological only (biopsies) and two cytological only (smears) specimens. Five biopsy specimens revealed severe and one mild coagulation patterned necrotic areas. Five had osteonecrosis. The cytological specimens also showed typical BMN patterns. Paracoccidioides brasiliensis yeast forms were visible within necrotic areas in all cases.

Motor performance of infants born small or appropriate for gestational age: a comparative study.

PURPOSE: To compare the motor performance of infants born small for gestational age (SGA) with those appropriate for gestational age (AGA) at 1, 2, 3, and 6 months. METHODS: A prospective cross-sectional study was conducted including infants born full-term, with birth weight under the 10th percentile for the SGA group and between the 10th and 90th percentiles for the AGA group. The Motor Scale of Bayley Scales of Infant Development-II was used to document motor performance. RESULTS: The SGA group presented a mean motor index score lower than the AGA group at 2 and 6 months, with the SGA group presenting fewer infants that successfully accomplished "makes crawling movements," "turns from side to back," "balances head," "sits alone momentarily," and "sits alone for 30 seconds." CONCLUSIONS: Data analysis suggested that infants who are SGA present greater risk of adverse outcomes that are detectable in motor performance measures at 2 months.

Human bcl-2 expression, cleaved caspase-3, and KSHV LANA-1 in Kaposi sarcoma lesions.

We aimed to evaluate the frequency of Kaposi sarcoma (KS)-associated herpesvirus (KSHV) infection in KS lesions in patients from Brazil. In addition, expression of human bcl-2, cleaved caspase-3, and KSHV latency-associated nuclear antigen (LANA)-1 in tumors was evaluated using immunohistochemical analysis. We studied 64 KS cases, classified as follows: classical, 20 (31%); iatrogenic, 2 (3%); AIDS-associated, 25 (39%); and not otherwise specified (lack of information about HIV status), 17 (27%). KSHV was detected by polymerase chain reaction (PCR) in 61 cases (95%); 40 cases (63%) were KSHV+ by PCR and immunohistochemical analysis for LANA-1. Immunoexpression of bcl-2 was detected in 47 cases (73%). Only a few cells in 15 cases (23%) of KS had demonstrable immunostaining for cleaved caspase-3. These results further support the association of KSHV with all KS forms. Cleaved caspase-3 in KS tumors was infrequent, which may reflect the inhibition of apoptosis owing to bcl-2 overexpression observed in the majority of KS tumors.

Agreement between scales for screening and diagnosis of motor development at 6 months.

OBJECTIVE: To ascertain the degree of agreement between a score for screening and another for diagnosis of motor development in 6-month old infants and to define the most appropriate cutoff point for screening. METHODS: A sectional study, enrolling asymptomatic full term newborns with gestational ages from 37 to 41 weeks, who were discharged from the maternity unit 2 days after birth and are resident in the Campinas area. Infants were excluded if they presented genetic syndromes, malformations, congenital infections, intensive care admission or low birth weight. The assessment instruments investigated were the Alberta Infant Motor Scale (AIMS) and the Bayley Scales of Infant Development II (BSID-II). Two cutoff points were evaluated for the AIMS, the 5th and 10th percentiles, and for the BSID-II infants were classified according to its motor index score (IS) as having inadequate (IS < 85, at least 1 standard deviation below the mean) or adequate performance (IS >or= 85, above the mean minus 1 standard deviation). RESULTS: The study sample comprised 43 infants. Six infants (14.00%) exhibited inadequate motor performance. Using the BSID-II motor classification and the 5th percentile AIMS cutoff, sensitivity was 100%, specificity 78.37%, accuracy 81.39%, kappa index 0.50 and p < 0.001; whereas, using the BSID-II motor classification and the 10th percentile AIMS cutoff, sensitivity was 100%, specificity 48.64%, accuracy 55.81%, kappa index 0.20 and p 0.025. CONCLUSIONS: The results suggest that concordance between the two 6-month assessment scales is good. The parameters employed are best combined using the 5th percentile AIMS cutoff point.

Agreement between scales for screening and diagnosis of motor development at 6 months

OBJETIVO: Verificar o grau de concordância entre uma escala de triagem e uma de diagnóstico do desenvolvimento motor de lactentes no sexto mês de vida, estabelecendo o ponto de corte mais apropriado para triagem. MÉTODOS: Estudo seccional, incluindo recém-nascidos a termo, com idade gestacional entre 37 e 41 semanas, assintomáticos, que receberam alta da maternidade 2 dias após o nascimento, residentes na região de Campinas. Foram excluídas síndromes genéticas, malformações, infecções congênitas, internações em unidade de terapia intensiva e baixo peso ao nascimento. Os instrumentos de avaliação foram: Alberta Infant Motor Scale (AIMS) e Bayley Scales of Infant Development II (BSID-II). Para a AIMS, foram utilizados dois pontos de corte, percentil 5 ou 10 e, para as BSID-II, foi utilizada a classificação dos lactentes na escala motora conforme a pontuação do index score (IS): desempenho inadequado (IS < 85, abaixo de menos 1 desvio padrão da média) ou desempenho adequado (IS > 85, maior ou igual a menos 1 desvio padrão da média). RESULTADOS: A amostra foi constituída por 43 lactentes. Seis lactentes (14,00 por cento) apresentaram desempenho motor inadequado. Considerando a classificação motora das BSID-II e o percentil 5 da AIMS, obteve-se sensibilidade = 100 por cento, especificidade = 78,37 por cento, acurácia = 81,39 por cento, índice kappa = 0,50 e p < 0,001; considerando a classificação motora das BSID-II e o percentil 10 da AIMS, obteve-se sensibilidade = 100 por cento, especificidade = 48,64 por cento, acurácia = 55,81 por cento, índice kappa = 0,20 e p = 0,025. CONCLUSÕES: Os resultados sugerem boa concordância entre os instrumentos de avaliação no sexto mês. A melhor combinação para os parâmetros analisados é a utilização do percentil 5 da AIMS.

OBJECTIVE: To ascertain the degree of agreement between a score for screening and another for diagnosis of motor development in 6-month old infants and to define the most appropriate cutoff point for screening. METHODS: A sectional study, enrolling asymptomatic full term newborns with gestational ages from 37 to 41 weeks, who were discharged from the maternity unit 2 days after birth and are resident in the Campinas area. Infants were excluded if they presented genetic syndromes, malformations, congenital infections, intensive care admission or low birth weight. The assessment instruments investigated were the Alberta Infant Motor Scale (AIMS) and the Bayley Scales of Infant Development II (BSID-II). Two cutoff points were evaluated for the AIMS, the 5th and 10th percentiles, and for the BSID-II infants were classified according to its motor index score (IS) as having inadequate (IS < 85, at least 1 standard deviation below the mean) or adequate performance (IS > 85, above the mean minus 1 standard deviation). RESULTS: The study sample comprised 43 infants. Six infants (14.00 percent) exhibited inadequate motor performance. Using the BSID-II motor classification and the 5th percentile AIMS cutoff, sensitivity was 100 percent, specificity 78.37 percent, accuracy 81.39 percent, kappa index 0.50 and p < 0.001; whereas, using the BSID-II motor classification and the 10th percentile AIMS cutoff, sensitivity was 100 percent, specificity 48.64 percent, accuracy 55.81 percent, kappa index 0.20 and p 0.025. CONCLUSIONS: The results suggest that concordance between the two 6-month assessment scales is good. The parameters employed are best combined using the 5th percentile AIMS cutoff point.

Human papillomavirus and Epstein-Barr virus infection, p53 expression, and cellular proliferation in laryngeal carcinoma.

Laryngeal carcinomas are aggressive neoplasms with controversial association with the human papillomavirus (HPV) and Epstein-Barr virus (EBV). So far, the impairment of p53 protein function and its impact on cellular proliferation has not been studied adequately in these tumors. In this work, molecular biologic techniques were used to assess the frequency of HPV and EBV in 110 squamous cell carcinomas of the larynx. In addition, accumulation of p53 and Ki-67 cell proliferation antigen expression in malignant cells was assessed by immunohistochemical analysis. High-grade HPV was found in 37.3% of cases, and none had demonstrable EBV infection. Accumulation of p53 was found in 78.2% of the cases, and it was related to a high Ki-67 labeling index and higher histologic grade. The results demonstrate association of HPV with more than one third of laryngeal carcinomas studied, mainly glottic tumors. Tumors with increased cell proliferation were more frequently high grade, with p53 accumulation and lymph node metastasis.

[Neurodevelopment of full-term small-for-gestational age infants in the second month of life]. / Neurodesenvolvimento de lactentes nascidos a termo pequenos para a idade gestacional no segundo mês de vida.

The objective of the present study was to assess and to compare the neurodevelopment of full-term adequate (AGA) or small-for-gestational age (SGA) infants in the second month of life. Sixty-seven infants were evaluated: 43 AGA and 24 SGA, making use of the Bayley Scales of Infant Development. The SGA group Index Score (IS) was significantly lower in Mental and Motor Scales. Considering the body proportionality (Asymmetric, Symmetric-SGA and Control group) there was difference in Motor Scale (p=0.003) with lower scores in the Symmetric-SGA group. Comparing to the Control group IS percentiles, in Mental Scale there was difference between Asymmetric X Symmetric-SGA; in Motor Scale, there was difference between the Asymmetric X Control (p=0.039) and Symmetric-SGA X Control (p=0.007) groups; there was no difference between Asymmetric and Symmetric-SGA although both exhibited lower scores than the Control group.

Neurodesenvolvimento de lactentes nascidos a termo pequenos para a idade gestacional no segundo mês de vida / Neurodevelopment of full-term small-for-gestacional age infants in the second month of life

O objetivo deste estudo foi avaliar e comparar o neurodesenvolvimento de lactentes nascidos a termo, com peso adequado (AIG) ou pequeno para a idade gestacional (PIG), no 2° mês de vida. Avaliaram-se 67 lactentes: 43 AIG e 24 PIG, utilizando as Bayley Scales of Infant Development. O Index Score (IS) nas Escalas Mental e Motora foi significativamente menor no grupo PIG. Considerando a proporcionalidade corporal (Grupos Controle, Assimétrico e PIG-Simétrico), houve diferença significativa na Escala Motora (p=0,003), com menores pontuações no grupo PIG-Simétrico. Comparados aos percentis de IS do grupo Controle, na Escala Mental, houve diferença entre os grupos Assimétrico X PIG-Simétrico; na Escala Motora, houve diferença entre os grupos Assimétrico X Controle (p=0,039) e PIG-Simétrico X Controle (p=0,0007); não houve diferença entre os grupos Assimétrico e PIG-Simétrico, ambos apresentando menores pontuações que o grupo Controle.

Peliosis hepatis associated with lymphoplasmacytic lymphoma: an autopsy case report.

A 72-year-old man with no previous history of liver disease was admitted to our university hospital with severe dyspnea, edema of the lower limbs, and weight loss. Within a few days of hospitalization, he died due to severe bleeding in the upper digestive tract. At autopsy, the liver displayed typical gross features of peliosis hepatis. In addition, a diffuse infiltration of liver, spleen, bone marrow, and lymph nodes by lymphoplasmacytic lymphoma was disclosed by light microscopy. In the liver, the neoplastic cells partially filled the peliotic cavities. Peliosis hepatis is a rare liver disease characterized by multiple blood-filled, dilated cavities within the liver parenchyma. Association of lymphoplasmacytic lymphoma and peliosis hepatis has rarely been reported in the literature. The pathologic findings of such an unusual association and a review of the literature are presented.

Emperipolesis in a case of B-cell lymphoma: a rare phenomenon outside of Rosai-Dorfman disease.

We describe a case of a diffuse large B-cell lymphoma with extensive emperipolesis phenomenon. Light microscopy revealed numerous CD68-positive/S-100-negative histiocytes containing viable neoplastic hematopoietic cells in their cytoplasm. Electron microscopy confirmed these findings. In this case, there was no evidence of Rosai-Dorfman disease either clinically or histologically. This report emphasizes that emperipolesis is not restricted to Rosai-Dorfman disease and can be found in other conditions including non-Hodgkin lymphomas.

Determinação da expressão da molécula de adesão CD56 em plasmócitos no mieloma múltiplo através de estudo imuno-histoquímico / CD56 adhesion molecule expression by plasma cells in multiple myeloma immunohistochemistry

O papel das moléculas de adesão celular, na fisiopatologia do mieloma múltiplo (MM), tem sido alvo de vários estudos nos últimos anos. A expressão de CD56 pelos plasmócitos tumorais está associada a comportamento clínico menos agressivo da doença, e sua perda tem sido descrita na fase de leucemização plasmocitária. A determinação da expressão da molécula CD56 pelos plasmócitos tumorais pode ser obtida através de citometria em fluxo, revelando positividade em 55 por cento a 78 por cento dos casos. No presente estudo, objetivamos verificar a expressão da molécula CD56 por plasmócitos tumorais na medula óssea de portadores de MM, utilizando o estudo imuno-histoquímico das amostras histológicas obtidas ao diagnóstico. Analisamos as amostras de medula óssea de vinte portadores de MM, e realizamos o estudo imuno-histoquímico para determinação da expressão das cadeias leves kappa e lambda e da molécula CD56 pelos plasmócitos tumorais. A expressão da molécula CD56 foi importante em três casos, moderada em seis, discreta em quatro e negativa em sete. O estudo imuno-histoquímico mostrou-se válido para determinação da expressão de CD56 por plasmócitos tumorais em portadores de MM, fornecendo resultados semelhantes aos descritos para os obtidos por citometria em fluxo. Através do estudo imuno-histoquímico, foi possível observar variações da expressão da molécula CD56

over the last years. The CD56 expression by neoplasticplasma cells is related to a less aggressive clinical course,and its loss is described in plasma cell leukemia. Theevaluation of the CD56 expression may be obtained byflow cytometry, with positivity in 55% to 78% of cases. Inthis study, we verified the CD56 expression by plasma cellsin bone marrow of myeloma patients usingimmunohistochemistry in samples obtained at diagnosis.We analyzed bone marrow of 20 myeloma patients andperformed immunohistochemistry to determine theexpression of the kappa and lambda light chains and CD56by neoplastic plasma cells. The CD56 expression wasimportant in three samples, moderate in six, discrete infour and negative in seven. Immunohistochemistry wasvalid to determinate CD56 expression by neoplastic plasmacells in myeloma patients, giving similar results whencompared with flow cytometry. It was possible to evaluatethe variations in the CD 56 expression using this method.The role of adhesion molecules in the physiopathologyof multiple myeloma has been the target of many studies.

[Clinical-radiologic correlation in chronic sinusitis]. / Correlación clinicorradiológica en sinusitis crónica.

INTRODUCTION: Chronic sinusitis is a pathology that has been increasing in incidence in world population. The Mexican Institute of Social Security (IMSS) reports 91 cases per year per 100,000 people. In the last decades, much has been advanced concerning knowledge of the physiology of paranasal sinuses and thus of the pathogenesis of sinusitis; this has led to developing of functional endoscopic sinus surgery. To perform this kind of surgery, it is mandatory to have computerized tomography, and the necessity of clinical-radiologic correlation has been recognized to attain better diagnosis and treatment. OBJECTIVE: To determine clinical-radiologic correlation of chronic sinusitis in adult patients. MATERIALS AND METHODS: Correlational, transverse, convenience-assigned blind study from January to July 2002 in the Department of Otolaryngology, Hospital de Especialidades at the Centro Médico Nacional Siglo XXI in Mexico City. Kendall test was applied to a group of 31 patients. RESULTS: Nasal obstruction was found in 87%, mucopurulent rhinorrea in 55%, mucosal edema in 74%, and polyps in 42%. Most frequently paranasal sinus affected by sinusitis was maxillary sinus in 97% and least affected was frontal, in 58%. Of tomographic findings, most frequent was obstruction of ostiomeatal complex in 84%. There was no statistical significance (p > 0.05) in clinical-radiologic. DISCUSSION: No correlation was found between signs and symptoms evaluated with tomographic findings, as reported by other authors.

Hodgkin disease in adult and juvenile groups from two different geographic regions in Brazil: characterization of clinicopathologic aspects and relationship with Epstein-Barr virus infection.

We analyzed clinicopathologic data, immunophenotype, and Epstein-Barr virus (EBV) status in 96 cases of Hodgkin disease (HD) in juveniles (younger than 20 years) and adults (20 years or older) from 2 distinctive states in Brazil. We studied 34 juvenile (group 1) and 16 adult (group 2) cases from Ceara and 31 juvenile (group 3) and 15 adult (group 4) cases from São Paulo. Ceara has a socioeconomic profile similar to a developing country; São Paulo is in better economic condition. Mixed cellularity (MC) was the major histologic subtype among groups 1 (22 [65%]), 3 (21 [68%]), and 4 (7 [47%]); nodular sclerosis (NS) was more frequent in group 2 (8 [50%]). EBV infection was observed in 61 cases (64%), including the following (among others): group 1, MC, 22 (65%) and NS, 4 (12%); group 2, NS, 3 (19%) and MC, 2 (12%); group 3, MC, 16 (52%) and NS, 1 (3%); and group 4, MC, 7 (47%). There was predominance of EBV+ HD cases in group 1 compared with group 3. HD in Brazilian patients is highly associated with EBV infection, but geographic differences reflect histologic subtypes and age distribution.

Linfoma de Burkitt com envolvimento focal do centro germinativo simulado hiperplasia linfóide reacional / Burkitt's lymphoma with focal involvement of germinal center simulating lymphoid hyperplasia

O desenvolvimento do centro germinativo pelo linfoma de Burkitt cria dificuldades diagnósticas de grande conseqüência clínica. Descrevemos o caso de uma criança do sexo masculino com nove meses de idade, com massa tumoral osteilítica localizada na mandíbula. Ao exame físico, gânglio cervical aumentado, próximo à massa. Gânglios paravertebrais aumentados foram observados através de tomografia computadorizada. A biopsia do gânglio paravertebrais aumentados foram observados através de tomografia computadorizada. A biópsia do gânglio cervical mostrou centros germinativos hiperplásicos ao lado de outros parcial ou totalmente substituídos pelo linfoma. O aspecto de "céu estrelado" simulava, ao pequeno aumento, uma hiperplasia linfóide reacional. O estudo dos diversos padröes de centro germinativo foi essencial para o diagnóstico. Exame imuno-histoquímico mostrou células neoplásicas CD20+; a hibridizaçäo in situ para a presença de EBV foi negativa